Liska Vaclav, Treska Vladislav, Holubec Lubos, Kormunda Stanislav, Skalicky Tomas, Sutnar Alan, Topolcan Ondrej
Department of Surgery, University Hospital Pilsen, Charles University Prague, Alej Svobody 80, 304 00 Pilsen, Czech Republic.
Hepatogastroenterology. 2007 Sep;54(78):1741-4.
BACKGROUND/AIMS: The authors evaluated the significance of various factors regarding the recurrence of colorectal liver metastases (CLM) after liver resection or radiofrequency ablation.
82 patients were operated on for CLM at our department between 1998 and 2003. Radical surgery was performed in 58 patients (74.4%), an palliative surgery in 20 (25.6%). Recurrence of the disease was recorded in 53 patients (71.6%), 21 (28.4%) were without any sign of recurrence. The factors examined in the multifactorial analysis were: age and sex, localization of the primary carcinoma, Dukes classification, grading, histology, microscopically free resection line, chemotherapy and radiotherapy after colorectal or liver surgery, different types of liver resection, radical versus palliative liver surgery, complication after liver surgery, laterality of metastatic process, number of metastases, blood transfusion, staging, repeated liver surgery. Long-rank and Wilcoxon test were used for the statistical evaluation.
The factors statistically significant for disease-free interval after liver surgery were: unilaterality of metastatic process, microscopically free resection line, radical versus palliative surgical treatment. The survival rates after liver surgery and after the primary operation were dependent on grading, age, radical versus palliative resection, Dukes classification and staging.
These factors could play an important role as predictors of colorectal cancer recurrence in patients' follow-up period after liver surgery for CLM.
背景/目的:作者评估了肝切除或射频消融术后结直肠癌肝转移(CLM)复发的各种因素的意义。
1998年至2003年间,我们科室对82例CLM患者进行了手术。58例患者(74.4%)接受了根治性手术,20例患者(25.6%)接受了姑息性手术。53例患者(71.6%)出现疾病复发,21例患者(28.4%)无任何复发迹象。多因素分析中考察的因素包括:年龄和性别、原发性癌的部位、Dukes分期、分级、组织学、显微镜下切缘阴性、结直肠或肝脏手术后的化疗和放疗、不同类型的肝切除、根治性与姑息性肝手术、肝脏手术后的并发症、转移灶的侧别、转移灶数量、输血、分期、再次肝脏手术。采用长秩检验和Wilcoxon检验进行统计学评估。
对肝脏手术后无病生存期有统计学意义的因素为:转移灶的单侧性、显微镜下切缘阴性、根治性与姑息性手术治疗。肝脏手术后和初次手术后的生存率取决于分级、年龄、根治性与姑息性切除、Dukes分期和分期。
在CLM肝切除术后患者的随访期,这些因素作为结直肠癌复发的预测指标可能发挥重要作用。